Sensitivity and Awareness Training

1. Sensitivity and Awareness Training

2. Objectives • Understand the goals of the Centers for Medicare & Medicaid Services related to this technical assistance. • Define the impact of mental illness on people with Medicare. • Recognize strategies for improving benefit counseling with people who have a mental illness.

3. Partnering with SHIPs The Ombudsman is charged with working with the SHIPs to facilitate the provision of information to beneficiaries.

4. Goals for SHIP Assistance Goal of the CMS Office of the Medicare Ombudsman (OMO) • To assist SHIPs and other community partners to build bridges and expand the network of help to beneficiaries with mental illnesses, disabilities, HIV/AIDS and other vulnerable populations. Pathway to Goal Fulfillment • Collaboration with Partners. • Development and implementation of a technical assistance program (TAP) focused on sensitivity and awareness of underserved populations and network expansion.

5. Your Contributions Matter This training today is a conversation • Share your experiences • Brainstorm successful techniques • Conversation not just a presentation

6. Definitions Mental Illness • “Health conditions that are characterized by alterations in thinking, mood, or behavior…associated with distress and/or impaired functioning.”—Mental Health: A Report of the Surgeon General, 1999 • “…No bright line separating health from illness, distress from disease.” – National Alliance on Mental Illness Mental Health • “Mental Health refers to the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity.”—Mental Health: A Report of the Surgeon General, 1999 • “Manifestations of mental disorders vary with age, gender, race, and culture.” – Healthy People, 2010

7. How Prevalent Is Mental Illness in the U.S.? • Mental illness causes more disability than heart disease and cancer. • There are more than 200 mental disorders, with anxiety being the most common. • More than a quarter of the population will experience an anxiety disorder during their lifetime. • About 20% of American’s suffer from a mental illness.

8. Conversation: Stigma of Mental Illness • In your experience, how does the stigma, embarrassment, and denial associated with mental illness get in the way of helping beneficiaries? • Are you aware of any mental illness myths that you need to set aside yourself?

9. Why Underserved? • Stigma, embarrassment, denial • Emotions that may be experienced by beneficiaries, caregivers, or SHIP counselors • Lack of a clear line between health and illness • Less than a third of people with diagnosable mental illness receive help.

10. Your Role • Build on existing Medicare benefit counseling skills by becoming more sensitive toward and aware of persons with mental illness. • Act within the parameters defined by your SHIP Director and training. SHIP Counselors are not expected to diagnosis or treat mental illness.

11. Mental Illnesses You May Encounter

12. Fact Sheets • Depression • Anxiety • Dementia

13. Conversation: Depression, Anxiety, Dementia What do you do when a person: • Cannot remember what they have selected, today or previously? • Starts becoming violent? • Does not seem connected to reality? • Wants to address all tasks associated with benefit selection at once? • Does not believe they can make benefit decisions?

14. Fact Sheets • Counseling People with Mental Illness

15. Medicare Benefits Counseling for People With Mental Illness

16. Conversation: Developing Strategies for Success What do you do when a person: • Becomes agitated? • Refuses or cannot provide information? • Requests an increasing amount of your time? • Will not stop talking about other problems in their lives? • Speaks angrily to you? • Cannot focus on the task at hand?

17. Counseling an Anxious Beneficiary • Tip Sheets • Counseling People with Mental Illness • What Should you Do in a Difficult Conversation? • Anxiety • What are some of the difficulties that behaviors associated with anxiety may create during a counseling session?

18. Strategies for Successful Conversations • Redirect the conversation if a person becomes agitated or resistant. • Ask for information in multiple ways. • Maintain boundaries. • Be empathetic and patient. • Be respectful of the person. • Put your feelings (but not your safety) aside.

19. Prescription Drug Coverage Counseling Key Conversations – • Prescribed dose vs. covered dose • Contingency plans • Step therapy • Annual costs and alternative funding sources

20. Connecting With Mental Health Resources

21. Conversation: Current Practice for Connecting to Mental Health Resources What do you do when a person: • Self-identifies with a mental illness and asks for assistance? • Displays what you perceive to be symptoms of a mental illness? • Exhibits crisis behaviors such as talk of suicide or harm to others? • Requests or seems to need a resource not provided by your SHIP?

22. Strategies for Connecting • Recognize that the best way to help is to make a connection with the appropriate expert. • Always act within the boundaries of your role as a SHIP Counselor as defined by your SHIP Director and training • You can connect by … • Having an awareness of your local mental health landscape. • Being familiar with national mental health resources.

23. Local Mental Health Landscape • Community Service Boards provide services to individuals in VA with mental illnesses, mental retardation or substance abuse disorders. • Department of Mental Health, Mental Retardation and Substance Abuse ServicesP.O. Box 1797Richmond, VA 23218-1797Phone: 804-786-3921Toll-free: 800-451-5544 Fax: 804-371-6638TDD: 804-371-8977 • Virginia Office for Protection & Advocacy1910 Byrd Avenue, Suite 5Richmond, VA 23230Phone: 804-225-2042 (TDD)Toll-free: 800-552-3962 (Statewide) Fax: 804-662-7057E-mail: general.vopa@vopa.virginia.govInternet: www.vopa.state.va.us

24. National Resources • Crisis Hotlines • Suicide • 1-800-273-TALK (8255) or 1-800-799-4889 (TTY) • 1-800-SUICIDE • Substance Abuse • 1-800-662-HELP (4357) • Substance Abuse and Mental Health Services Administration (SAMSHA) • http://mentalhealth.samhsa.gov/databases/ • 1-800-789-2647

25. National Resources, Continued • Other Resources • The American Psychiatric Association • www.psych.org • American Psychological Association • www.apa.org • Mental Health America • http://www.nmha.org/ • National Alliance on Mental Illness • http://www.nami.org/ • National Council on Community and Behavioral Health Care (NCCBH) • http://www.nccbh.org/

26. Summary • CMS goals related to SHIP TAP • Facilitate the provision of information to people with Medicare. • Reach out to vulnerable populations. • Work with partners to improve service to people with Medicare. • Mental illness • Impacts people of all ages and social structures. • Responsible for more disability than any other illness. • Strategies for success • Appropriate tools for diverse situations.

27. Sensitivity & Awareness Training. Lynne Tierney CMS RO Health Insurance Specialist Trudy Maske Virginia VICAP Director